Tuesday, October 19, 2010

DIAGNOSIS VS. RELIEF

In the October 18 posting, I mentioned the tendency within current healthcare to favor diagnosis over subjective goals like relief and comfort.

No sooner did I write that than I heard from a good friend who’s been suffering abdominal pains for several months. She saw the least invasive and least expensive practitioners first—a chiropractor, acupuncturist, and body worker. Their treatments, which were intended to simultaneously diagnose and treat her symptoms (e.g., “See what avoiding gluten for a couple of weeks does to your pain level”), proved unsuccessful.

Finally, anxious that the problem might be a surgical condition like cancer, she saw a physician’s assistant and the PA’s physician supervisor. My friend left with a sheaf of test orders.

A day later, still hurting, she said, “Wow! I just realized that they only ordered tests. They didn’t offer me anything to relieve my symptoms.” True, she never requested pain meds, but I find it remarkable that the doc and PA suggested none anyway.

I know these practitioners, and respect them for their kindness and thoroughness. Yet they, too, inhabit a subculture in which diagnosis flashes in neon colors while relief molders in the shadows.

I doubt my friend will take it upon herself to educate them, as she’s preoccupied with her symptoms. In any case, this imbalance between diagnosis and relief pervades the system. That’s just one little reason why “healthcare reform” can’t simply consist of who pays for what. We need to rebuild healthcare from the foundation up.

1 comment:

Wow. This mirrors almost exactly the very strange experience I had a few years ago, when, never before having had any significant abdominal issues, I found myself one night doubled over in pain with cramps. For whatever reason, my intuition told me it was the pork I had eaten that afternoon in the hospital cafeteria (and shortly thereafter, the New York Times featured a story about the unsanitary conditions in pig farms in China leading to contamination of heparin in the U.S, and I wondered if some of our food also comes from those farms...) Weeks of laborious visits to the most highly rated GI specialists, slews of tests, revealed nothing...Rifampin, anti-spasmodic pills, anti-depressants, and dietary changes...nothing alleviated my symptoms significantly...without warning, at various points, I would be gripped by intense abdominal pain, and my stools would be alternately loose or constipated....and basically, if you don't have the known GI conditions, irritable bowel syndrome seems to be the catch-all diagnosis they give you when everything else is ruled out....So, I gave up all the meds, went back to the diet I prefer (basically "real," traditional farm foods--grass-fed, pastured eggs and meats, real butter, whole cream milk, raw milk cheeses, and plenty of vegetables), and very gradually, over two or three years, the pain subsided...and my stools have never fully returned to normal, but are about 80% there....I suspect that as mass industrialization of farming continues, there are new organisms that we have not identified causing ailments...just like it took years of ulcers before the Nobel prize winners discovered Helicobacter pylori...and that genetics plays a role in deciding who is and is not susceptible to these organisms...Sadly, we obsess on the superbugs in the hospital we know about, and rightly so, because they do cause tremendous suffering and death...but more frustrating is being on the wave of the sufferers of the as yet unidentified organism...and, perhaps my gradual recovery points to the natural healing and antibiotic properties of our bodies without the aid of medicines...to effectively knock back noxious organisms to the point that our existence is livable again...after all, our bodies are teeming with "natural" populations of microbes, healthful and harmful, in relative symbiosis...yet all our capacity to identify, label, or mis-identify causes does nothing to alleviate real pain...nor do we have such nuances of language to encourage people to delve into and describe acute or chronic, fleeting, intense, or subtle varieties of pain...nor can we when we are bound in half by excruciating pain through which one can barely breathe....But I do hope your friend finds that if there is no magical cure-all, her symptoms naturally subside over time....

About Me

My medical practice consists exclusively of listening to patients and their families. Having limited my focus since the late 1970s to cancer support group facilitation, I founded the support programs at Sutter Cancer Center in Sacramento and Sierra Nevada Cancer Center in Grass Valley, CA.
I’ve published dozens of periodical articles on the healing relationship. My most recent book is How to Heal: A Guide for Caregivers (Helios Press, 2003). I teach medical practitioners “bedside manner” in workshops nationally.